“When first-line agents for bipolar disorder lead to an improvement in symptoms but not to complete remission, or if someone cannot tolerate first-line agents, other classes of psychotropic medications can be utilized, typically as adjuvant to the mainstream treatment,” says Paula Zimbrean, MD, a psychiatrist and a professor of psychiatry at Yale School of Medicine in New Haven, Connecticut.
But symptoms of depression are more persistent, says Zimbrean. “So patients with lots of depression may have a second medication recommended, but that may occur later in treatment.”
Depression in bipolar disorder is very difficult to treat, says Kumar. “Because traditional antidepressants can cause mania, they can worsen symptoms and even destabilize mood.” But your provider can help you discover the best combination of medications to treat your bipolar symptoms.